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Clinical Correlates of Surveillance Events Detected by National Healthcare Safety Network Pneumonia and Lower Respiratory Infection Definitions—Pennsylvania, 2011–2012

Published online by Cambridge University Press:  13 April 2016

Isaac See ,
Julia Chang ,
Nicole Gualandi ,
Genevieve L. Buser ,
Pamela Rohrbach ,
Debra A. Smeltz ,
Mary Jo Bellush ,
Susan E. Coffin ,
Jane M. Gould  and
Debra Hess
...Show all authors
Isaac See*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA
Julia Chang
Affiliation:
UCLA Geffen School of Medicine, Los Angeles, California
Nicole Gualandi
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Genevieve L. Buser
Affiliation:
Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA Oregon Health Authority, Portland, Oregon
Pamela Rohrbach
Affiliation:
Pennsylvania Department of Health, Harrisburg, Pennsylvania
Debra A. Smeltz
Affiliation:
Pennsylvania Department of Health, Harrisburg, Pennsylvania
Mary Jo Bellush
Affiliation:
Excela Health Westmoreland Hospital, Greensburg, Pennsylvania
Susan E. Coffin
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Jane M. Gould
Affiliation:
St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
Debra Hess
Affiliation:
Lancaster General Hospital, Lancaster, PA
Patricia Hennessey
Affiliation:
St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
Sydney Hubbard
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Andrea Kiernan
Affiliation:
St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
Judith O’Donnell
Affiliation:
Pennsylvania Presbyterian Medical Center, Philadelphia, Pennsylvania
David A. Pegues
Affiliation:
University of Pennsylvania Health System, Philadelphia, Pennsylvania
Jeffrey R. Miller
Affiliation:
Office of Public Health Preparedness and Response, CDC, assigned to the Pennsylvania Department of Health, Harrisburg, Pennsylvania
Shelley S. Magill
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Address correspondence to Isaac See, MD, 1600 Clifton Road, MS A-16, Atlanta, GA 30329-4027 (isee@cdc.gov).
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Abstract

OBJECTIVE

To determine the clinical diagnoses associated with the National Healthcare Safety Network (NHSN) pneumonia (PNEU) or lower respiratory infection (LRI) surveillance events

DESIGN

Retrospective chart review

SETTING

A convenience sample of 8 acute-care hospitals in Pennsylvania

PATIENTS

All patients hospitalized during 2011–2012

METHODS

Medical records were reviewed from a random sample of patients reported to the NHSN to have PNEU or LRI, excluding adults with ventilator-associated PNEU. Documented clinical diagnoses corresponding temporally to the PNEU and LRI events were recorded.

RESULTS

We reviewed 250 (30%) of 838 eligible PNEU and LRI events reported to the NHSN; 29 reported events (12%) fulfilled neither PNEU nor LRI case criteria. Differences interpreting radiology reports accounted for most misclassifications. Of 81 PNEU events in adults not on mechanical ventilation, 84% had clinician-diagnosed pneumonia; of these, 25% were attributed to aspiration. Of 43 adult LRI, 88% were in mechanically ventilated patients and 35% had no corresponding clinical diagnosis (infectious or noninfectious) documented at the time of LRI. Of 36 pediatric PNEU events, 72% were ventilator associated, and 70% corresponded to a clinical pneumonia diagnosis. Of 61 pediatric LRI patients, 84% were mechanically ventilated and 21% had no corresponding clinical diagnosis documented.

CONCLUSIONS

In adults not on mechanical ventilation and in children, most NHSN-defined PNEU events corresponded with compatible clinical conditions documented in the medical record. In contrast, NHSN LRI events often did not. As a result, substantial modifications to the LRI definitions were implemented in 2015.

Infect Control Hosp Epidemiol 2016;37:818–824

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 7 , July 2016 , pp. 818 - 824
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION: This study was presented in part in abstract 894 at the 2014 IDWeek conference, Philadelphia, Pennsylvania, on October 10, 2014.

References

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